Chapter 16, Page 4

Tests on the Cervical Mucus

Problems with cervical mucus usually cause no symptoms. Tests need to be done to assess whether the mucus is normal or not.

The doctor examines the cervix and the cervical mucus daily from about the tenth day of the period. The mouth of the cervix is graded, depending upon how open it is; and the mucus is graded for its amount; its stretchability (spinnbarkeit); and its ability to fern. For the ferning test, a small drop of mucus is placed on a glass slide and allowed to dry. It should crystallize, forming branches which look very like fern leaves. These grades are added to give an Insler mucus score. Healthy cervical mucus is profuse in volume; very stretchable (upto 10 cm in length); and ferns easily.

The post-coital test (PCT)

This is one of the oldest tests in investigating infertility and has been done for well over 100years. Timing the PCT is critical, and it must be done in the preovulatory period, when the mucus is profuse and clear. The gynecologist examines a small sample of the cervical mucus under a microscope some hours after sexual intercourse. The mucus is sucked painlessly from the cervical canal during an internal examination. Most doctors feel that the best time to do this is about 6 to 24 hours after sex, but this timing is not critical. The test is said to be positive if many normal live sperm are seen swimming in the mucus sample. The sperm should be swimming in a fairly straight line and reasonably vigorously. A positive PCT is very reassuring and implies that:

  1. The husband is likely to be producing enough normal sperm
  2. ntercourse results in semen being deposited in the vagina
  3. The cervical glands are healthy
  4. Sufficient estrogen is being produced before ovulation, suggesting that ovulation is normal.
  5. There are no antibodies in the mucus hostile to the sperm.

What if the PCT is negative (that is, no sperm are seen in the mucus; or they are all dead)?

Some of the reasons for a negative test are:

  1. The PCT was not done at the best time. For example, the PCT may have been done too early or too late in the cycle. Wrong timing is the commonest reason for a negative test and can even cause repeatedly negative results.
  2. There was no ovulation during the month of the test perhaps because of the strain or stress of making love to order.
  3. The sperm count was poor. Obviously, men with persistently low sperm counts, or men with poorly motile sperm, may be responsible for a negative PCT.
  4. There may be an abnormality of the cervix - for example, chronic infection in the cervix may prevent production of adequate mucus; and some women with a scarred cervix may not produce enough mucus. Patients who have had surgery on the cervix (for example, cervical conisation, in which a cone of cervical tissue is removed to treat cervical dysplasia) often have this problem.
  5. The cervix is producing antibodies to the sperm.
  6. Medications such as clomiphene, tamoxifen, progesterones and danazol - all drugs used for treating infertility problems - can interfere with the production of good mucus.

Remember that a negative test is meaningful only if it is repeatedly negative under perfect conditions.

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Credits: How to Have a Baby: Overcoming Infertility

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